Inpatient DRG Quality Auditor

Humana; Orlando (FL); Remote; USD 65,000 - 89,000; Full time

Job summary

Join a forward-thinking company dedicated to health and wellness as an Inpatient Medical Coding Auditor. In this remote role, you'll conduct quality reviews of coding processes, focusing on DRG audits while driving process improvements. Your expertise will help ensure proper reimbursement and enhance the quality of care. This role offers flexibility and the chance to make a significant impact in a Fortune 100 environment that values your skills and dedication. If you're passionate about healthcare and ready to contribute to a caring community, this opportunity is perfect for you.

Benefits

Medical, dental, and vision benefits

401(k) retirement savings plan

Paid time off

Short-term and long-term disability

Life insurance

Professional development opportunities

Qualifications

• 7+ years of experience in DRG coding and quality auditing.
• Proficient in medical coding and record review.

Responsibilities

• Conduct quality reviews of coding processes and drive process improvements.
• Develop educational materials for coding processes.

Skills

DRG Coding

Quality Auditing

Medical coding certification (AHIMA)

Critical thinking skills

MS Office proficiency

Education

Medical coding certification

Tools

MS Office

Job description

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This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$65,000.00/yr - $88,600.00/yr

Become a part of our caring community and help us put health first

In this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus on DRG audits. You will also drive process improvement initiatives and develop educational materials. This is a full-time, remote/work-from-home position.

Description

The Inpatient Medical Coding Auditor extracts clinical information from medical records and assigns appropriate codes (e.g., ICD-10-CM, CPT). This role involves analyzing moderately to highly complex issues requiring in-depth evaluation of variable factors.

Where you Come In

The Coding Quality Team is looking is an experienced and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG)

So, do you love working on several different projects? Do you take pride in helping others and being flexible? Do you pay great attention to detail and have a passion for healthcare? Do you have a solid background in medical auditing, coding, and medical record review? If you answered YES to one or more of the above, you should strongly consider this role.

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Use Your Skills To Make An Impact

WORK STYLE: 100% remote/work at home

WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Some flexibility might be possible, depending on business needs

Responsibilities

In this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus on DRG audits. You will also drive process improvement initiatives and develop educational materials. This is a full-time, remote/work-from-home position.

Required Qualifications

• 7+ years of DRG Coding
• 5 years of Quality Auditing
• Medical coding certification from AHIMA (RHIT, CCS, CICA, CHCA)
• Prior experience reading and coding from medical records.
• Strong critical thinking skills.
• Proficient in independently managing diverse priorities, adept at swiftly transitioning between tasks based on urgency and demand with minimal instruction.
• Demonstrated ability to work independently and manage workload.
• Exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence, and commitment to the profession.
• Excellent writing, editing, interpersonal, planning, teamwork, and communication skills.
• Proficient in MS Office applications including Word, Excel, Outlook, PowerPoint.
• Proven ability to work independently.
  
  

Work at Home Requirements

• Must be able to provide ahigh-speedDSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
• A dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.
  
  

Preferred Qualifications

• CAS, MOATS and FR experience.
• Process improvement experience.
• Multi-Specialty Auditing experience.
  
  

Scheduled Weekly Hours- 40

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 05-06-2025

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Quality Assurance

• Industries

  Insurance

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